High-risk Factors and a Nomogram Prediction Modelfor Pulmonary Fungal Infection in Elderly Patientswith Acute Exacerbation of Chronic Obstructive Pulmonary Disease
DOI:
https://doi.org/10.71321/d3zf3339Keywords:
elderly acute exacerbation of chronic obstructive pulmonary disease, fungal infection, risk factors, nomogram, prediction modelAbstract
Background: Pulmonary fungal infection is a major risk factor for death and prolonged hospitalization in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). At present, early recognition of these infections remains difficult. This study therefore collected clinical data to develop an early-prediction model for fungal pneumonia complicating AECOPD.
Methods: We enrolled 404 elderly AECOPD patients admitted to the Department of Respiratory Medicine, First Affiliated Hospital of Anhui Medical University, from January to December 2023. The cohort was randomly split 7:3 into a training set (n =283) and a validation set (n =121). Univariate logistic regression was first performed in the training set; variables with p < 0.05 were entered into a multivariate model. Significant factors were used to construct a nomogram. Model performance was evaluated in both sets by the area under the receiver operating characteristic curve (AUC), calibration plots, and decision-curve analysis (DCA).
Results: Smoking history, length of hospital stay, concomitant cardiovascular disease, glucocorticoid use, and the neutrophil-to-lymphocyte ratio (NLR) were independent risk factors for fungal infection during AECOPD (p < 0.05). The nomogram achieved AUCs of 0.884[95% CI: 0.838–0.930] in the training set and 0.879 [95% CI: 0.795–0.962] in the validation set. Calibration and DCA curves indicated good clinical utility.
Conclusion: Smoking history, prolonged hospitalization, concurrent cardiovascular disease, glucocorticoid therapy, and elevated NLR are independent risk factors for fungal infection in AECOPD. The constructed nomogram exhibits strong predictive performance.
References
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